In development we try for a lot of behavior change. It’s easy to train people. We can sit a bunch of mothers down and explain why all the latest research shows that giving their baby water instead of breastmilk, what they’ve always done, is unhealthy. But it’s a rare that explanation wins out against imbedded practice.
A recent New Yorker article called “Slow Ideas” by Atul Gawande asks why some innovations spread fast, and others slow? He pulls examples from surgery. Anesthesia caught on like wildfire once it was discovered in the mid-1800s, making once-agonizing surgery virtually painless. Antiseptics, on the other hand, took decades to be widespread despite being discovered around the same time and tackling the very real problem of infection. Why?
His answer twofold: “First, one combatted a visible and immediate problem (pain); the other combatted an invisible problem (germs)… Second, while both made life better for patients, only [anesthesia] made life better for doctors” who no longer had to operate on people while they thrashed around. So, to catch on quickly, the change had to solve a problem that was inconvenient for the person who could make the change.
Another key, for Gawande, is the source of the information. Sales reps use repeated contact to establish trust with potential clients; the “rule of seven touches.” This human contact may be even more important in many developing countries, where trust is often more rooted in social networks.
There are two elements that Gawande hints at in his article, which I think merit a little more discussion.
First: the visibility of cause-and-effect. With anesthesia, it’s easy to see that ether works. A “trial run” would show dramatic results: with it, patients lie calmly; without, they trash in agony. But with antisepsis, the treatment is applied during the procedure but the effects don’t manifest themselves until later. And, just one tiny mistake in the complicated process of sterilizing everything can lead to an infection just the same. A “trial run” of antisepsis might reduce the likelihood that a patient would get an infection, or might reduce the seriousness of that infection; far less dramatic.
So, being able to see clearly that the change works to fix the problem is an important factor in adoption.
Second: the beliefs that underlie people’s behavior. Gawande briefly suggests that skepticism about germ theory in the 1800s may have slowed the spread of antisepsis. But the influence of deeply-held beliefs – or even general suspicion of new ideas – has the potential to be a powerful, and hidden, barrier to behavior change. A good example here is female genital mutilation, a practice that in many places is integral to people’s idea of womanhood. You can go around talking up the proven health benefits of ending the practice itself, but people will see that as an attack on no less than their cultural identity.
So, the social and cultural factors that underlie current behavior are also an important factor for development actors working to change behavior.
With all this in mind, below are five questions that should be considered in any behavior change efforts:
- How visible / inconvenient is the problem for people who could make the change?
- How easy is this change to do properly, compared to the inconvenience of the problem?
- How easy to see is the cause-and-effect of the change fixing the problem?
- How deeply held are current beliefs about the nature of the problem?
- How credible / relatable is the source / medium of information for the recipient?
I’m sure that I’m not the first person to think of these things, and that others have developed these concepts much more in depth. I will keep looking into this & very happy to hear any suggestions!